Cadaver Donor Kidney for Non-Compliant Dialysis Patient

Abstract

A 32 year old postman had progressive diabetic nephropathy due to insulin-dependent (type 1 ) diabetes with onset at the age of 17 years, disrupting the patient’s plans for a career in professional football. Despite counseling at school, the patient followed a consistent pattern of minimal compliance with his medical regimen. He had two or more episodes of ketoacidosis per year for the past decade but failed to perform finger stick blood glucose tests. Although he sustained a “minor stroke” due to uncontrolled hypertension, the patient rarely took antihypertensive or diuretic medications. He is blind in the right eye because of retinal hemorrhages but missed several recent appointments for laser surgery of the left eye — a vital step to preserve vision. While the right great toe has been amputated because of an nonhealing ulcer, the patient has not accepted a prescription for orthopedically correct “old ladies” shoes. Currently, the patient is consistently late for hemodialysis appointments, gains more than five kgs between treatments because of dietary indiscretion, and does not test his blood glucose level. Requesting a place on the transplant recipient list, the patient states that should he be given a new kidney, “I will try to do what the doctors say.” In the opinion of the patient’s nephrologist, a kidney transplant for this patient is a wasted organ, a past pattern of noncompliance is sufficient to presume future noncompliance.